Healthcare Provider Details

I. General information

NPI: 1952528739
Provider Name (Legal Business Name): FRED GILBEAUX, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4583 NORTH ST
JAMESVILLE NY
13078-9461
US

IV. Provider business mailing address

4583 NORTH ST
JAMESVILLE NY
13078-9461
US

V. Phone/Fax

Practice location:
  • Phone: 315-492-4000
  • Fax: 315-469-3029
Mailing address:
  • Phone: 315-492-4000
  • Fax: 315-469-3029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number043820
License Number StateNY

VIII. Authorized Official

Name: DR. FREDERICK CHARLES GILBEAUX
Title or Position: PRESIDENT
Credential: DDS
Phone: 315-492-4000